Citation NR: 9723839
Decision Date: 07/09/97 Archive Date: 07/21/97
DOCKET NO. 94-05 975 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in New York,
New York
THE ISSUE
Whether new and material evidence has been submitted to
reopen a claim for service connection for a psychiatric
condition to include post traumatic stress disorder (PTSD).
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
D. Schechter, Associate Counsel
INTRODUCTION
The veteran served in the active military from September 1941
to September 1945.
This appeal before the Board of Veterans Appeals (Board)
originated from a March 1992 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
New York, New York, determining that new and material
evidence had not been received to reopen the veteran’s claim
for entitlement to service connection for a psychiatric
condition to include PTSD. A notice of disagreement was
received in November 1992. A statement of the case was
issued in February 1993. A substantive appeal was received
from the veteran in February 1993. An RO hearing was
conducted in May 1993. A hearing officer decision was issued
in May 1993. The case was certified for appeal by the RO in
June 1996.
In July 1996 the Board of Veterans’ Appeals reviewed and
remanded the claim for RO review and RO issuance of a
supplemental statement of the case, pursuant to 38 C.F.R.
§§ 19.31, 19.37, 20.1304 (1996). An additional supplemental
statement of the case must be furnished to the appellant and
his representative when additional pertinent evidence is
received after a statement of the case is issued. 38 C.F.R.
§ 19.31 (1996). After the RO’s February 1997 issuance of a
supplemental statement of the case, the veteran submitted no
new evidence. The veteran submitted a statement in February
1997 which contained evidentiary statements related to his
claim that were merely duplicative of statements previously
made. A February 1997 statement from the veteran’s
representative indicated that the veteran had no additional
evidence to submit.
With development requested in the July 1996 remand completed,
the claim is now properly before the Board for review.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends, in effect, that he has submitted new
and material evidence to reopen his claim for entitlement to
service connection for a psychiatric condition to include
PTSD. The veteran further contends, in effect, that he
developed his psychiatric condition in service, and that it
has persisted, with intermittent treatment post service, from
service until the present time. The veteran therefore
contends that he is entitled to service connection for a
psychiatric condition to include PTSD.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1996), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that new and material evidence has
been submitted to reopen the veteran’s claim for service
connection for a psychiatric condition to include PTSD. It
is also the decision of the Board that the preponderance of
the evidence favors a grant of service connection for a
psychiatric condition. However, the preponderance of the
evidence is against the veteran’s claim that his psychiatric
condition is PTSD.
FINDINGS OF FACT
1. Evidence received since the last final decision by the
Board in February 1991 raises a reasonable possibility that a
review of the entire record would result in a different
outcome on the veteran’s claim for entitlement to service
connection for a psychiatric condition to include PTSD.
2. The veteran has an anxiety disorder which is the result
of military service.
3. There is no current diagnosis of PTSD.
CONCLUSIONS OF LAW
1. New and material evidence has been received since the
RO’s last final decision denying service connection for a
psychiatric condition to include PTSD, and the veteran’s
claim for that benefit has been reopened. 38 U.S.C.A.
§§ 5108, 7105 (West 1991); 38 C.F.R. § 3.156 (1996).
2. An anxiety disorder was incurred in active service. 38
U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1996).
3. PTSD was not incurred in service. 38 U.S.C.A. §§ 1110,
5107 (West 1991); 38 C.F.R. § 3.303 (1996).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
A claim that has been disallowed may be reopened upon the
presentation of new and material evidence. 38 U.S.C.A. § 5108
(West 1991). Evidence is considered new when it is not
merely cumulative of other evidence in the record and is
considered material when it is relevant and probative of the
issue at hand. 38 C.F.R. § 3.156 (1996). Further, the
United States Court of Veterans Appeals (Court) has
established a two-step analysis which must be applied in
cases in which a claimant seeks to reopen a claim which has
become final.
First, there must be a determination as to whether there is
new and material evidence to reopen the claim. If there is
such evidence, the claim must be reviewed on the basis of all
of the evidence, both old and new. Manio v. Derwinski,
1 Vet.App. 140 (1991). The Court has defined "new" evidence
as evidence which is neither cumulative nor redundant and
"material" evidence as that which is relevant and probative
as to the issue presented. Colvin v. Derwinski, 1 Vet.App.
171 (1991). Moreover, the additional evidence must provide a
reasonable possibility of changing the outcome when viewed in
the context of all of the evidence, new and old. Smith v.
Derwinski, 1 Vet.App. 178 (1991). Finally, if the evidence
is found to be new and material under these guidelines, the
claim is reopened and the Board must evaluate the merits of
the veteran's claim in light of all of the evidence.
Therefore, in assessing the sufficiency of the additional
evidence for purposes of reopening a claim, a critical
examination of all the evidence of record is necessary,
particularly for determining the "materiality" of such
evidence. The Court has stated that the credibility of new
evidence is to be presumed for these purposes. Therefore, if
such evidence presents a reasonable possibility of changing
the outcome, then the claim is reopened. Thus, the ultimate
credibility or weight to be accorded such evidence must be
determined as a question of fact. Justus v. Principi, 3
Vet.App. 510 (1992).
Recently, the Court, in Evans v. Brown, 9 Vet.App. 276
(1996), noted that the first step of the Manio two-step
process as to a claim to reopen involves three questions:
Question 1: Is the newly presented evidence “new” (that is,
not of record at the time of the last final disallowance of
the claim and not merely cumulative of other evidence that
was then of record...)? Question 2: Is it “probative” to
“the issue[s] at hand”...(that is, each issue which was a
specified basis for the last final disallowance...)?
Question 3: If it is new and probative, then, in light of
all of the evidence of record, is there a reasonable
possibility that the outcome of the claim on the merits would
be changed...? [A]ffirmative answers to both questions 2 and
3 - involving the probative nature of the “new” evidence and
the reasonable possibility of outcome change, respectively -
are required in order for “new” evidence to be “material”.
Prior to the RO decision herein appealed, the veteran was
most recently denied service connection for a psychiatric
condition to include post traumatic stress disorder (PTSD) in
March 1992, for lack of new and material evidence to reopen
that claim, upon a finding that evidence submitted, including
veteran’s statements and duplicate information, was not
material. However, since a substantive appeal perfected the
veteran’s appeal of the November 1992 denial in February
1993, the March 1992 RO decision never became final prior to
this appeal.
Prior to the March 1992 denial, the Board of Veterans’
Appeals (Board) denied the claim in a February 1991 decision.
The Board denied the claim because subsequent to a February
1980 RO rating action denying the claim, no new factual basis
was presented to justify service connection for a psychiatric
disorder, and because PTSD was not incurred or aggravated in
service. While the Board then reviewed contentions by the
veteran of stressors in service and of a nervous condition
beginning in service, and reviewed statements by service
comrades and documentation of medals received for his
service, the Board found, in effect, that the evidence
presented was not sufficient to establish that the veteran
experienced stressors in service, or that the veteran’s
psychiatric condition had its onset in service.
Significantly, the Board found that the veteran’s service
comrades were vague about the veteran’s alleged treatment for
a nervous disorder at Utah Beach in service; that the
possibility of a link between a generalized anxiety disorder
and his service raised by a July 1989 VA examiner was based
on the veteran history and not supported by objective medical
evidence; that according to a letter from Dr. Derrico, a
private physician, he had first treated the veteran for
anxiety neurosis five years post service; and that Dr.
Amidon, who had reportedly met the veteran when he was
serving as a physician and the veteran was serving as an
enlistee in June of 1944, was frank in letters he submitted
that he had difficulty remembering both the veteran and the
alleged incident of treatment at Utah Beach in service,
because of the passage of time.
The Board notes that in his November 1989 letter, Dr. Amidon
stated that though he did not remember what transpired during
the alleged morning of treatment on June 6, 1944, and did not
remember treating the veteran for a nervous condition, he did
remembered that for a period of time the veteran was not able
to function properly and was allowed to rest in the aid
station. In a March 1977 letter to the veteran, Dr. Amidon
stated that it may well be true that he treated the veteran
for nervousness, but that he did not remember the exact
circumstances surrounding his seeing the veteran on the Beach
on D-day during the invasion of Normandy. In an April 1979
letter to the veteran’s son, Dr. Amidon stated that he knew
the veteran quite well because they were in the same outfit,
but that he did not recall any “detailed circumstances”
regarding June 6, 1944, and that it was understandable that
he did not recall given the number of casualties being
treated at that time.
The veteran’s service medical record, of record prior to the
last prior denial, contains no record of complaints or
treatments for an psychiatric condition, and the veteran’s
service separation examination in September 1945, contains no
psychiatric diagnosis.
The veteran’s service separation WD AGO Form 53-55, of record
prior to the last final denial, indicated that the veteran
was in the battles or campaigns of Central Europe, Naples,
Foggia, Normandy, Northern France, Rhineland, Rome, Arno,
Sicily, and Tunisia.
Unit histories submitted prior to the last prior denial
showed that the 531st Engineering Shore Regiment engaged in
extensive combat, including assault of Utah Beach, on the
coast of France, on June 6, 1944.
In a November 1976 letter from Nicholas Derrico, M.D., a
private physician, received into the claims file in May 1977,
the physician stated that the veteran was a patient at that
office since 1950, that his main problem was anxiety
neurosis, and that he had been seen intermittently about
twice yearly for that problem.
Fellow comrades submitted into the record prior to the
February 1991 Board decision several statements in support of
the veteran’s claim. One comrade, in a letter dated February
1974, stated that he knew the veteran in service and knew him
to be a very trustworthy and sincere person, and added that
the veteran had become very nervous, upset, and extremely
emotional following the invasion of Sicily, and that the
nervousness persisted through the invasion of Italy and until
the invasion of France. Another, in a July 1976 letter,
stated that he had met the veteran on D-Day and that at that
time the veteran was in a state of shock. Another comrade,
in a June 1976 letter, stated he was in the aid station on
June 6, 1944, helping treat the wounded, when the veteran was
admitted suffering from shock, and was made comfortable and
was released in a few days. Another comrade, in a July 1976
letter, stated that veteran was a member of the 531st
Engineering Shore Regiment when they landed in Normandy,
France, on June 6, 1944, and added that though the veteran
was a nervous person at the time, the veteran was treated by
medics at that time. That comrade added that to the best of
his knowledge the veteran had returned for periodic checkups.
Another comrade, in an August 1976 letter, stated that he was
in the same company as the veteran during the invasion of
North Africa on Utah beach, and that during that invasion the
veteran suffered a “nervous breakdown.” Another, in a
September 1976 letter, stated that he believed that the
veteran had been shook up when the veteran, together with the
headquarters company of the 3051st combat engineers, was
shelled by Germans upon landing on a beachhead, and he
believed the veteran was treated for nervousness. Another
comrade, in a letter received into the record in May 1977,
stated that he was of the 531st Engineering Shore regiment
with the veteran, and that he observed the veteran constantly
on sick call for nerves. The same comrade who submitted the
June 1976 letter, in a letter dated February 1979, stated
that both he and the veteran were part of the 3051st Combat
Engineering Battalion, and that on June 6, 1944, they were on
Utah Beach and were bombed all day, that he was in the first
aid station when the veteran was brought in, that Captain
Amidon was the doctor in charge there, and that the veteran
was then treated for shell shock and for some time was unable
to resume normal duties. The same comrade who submitted the
August 1976 letter, in a letter dated October 1979, stated
that during the Invasion of Utah Beach, D-day, H. Hour, he
saw the veteran going to the first aid station for help.
In testimony and statements submitted by the veteran prior to
the last final denial in February 1991, the veteran stated,
in effect, that he suffered from shell shock upon the landing
on Utah Beach on June 6, 1944, in service; that he saw
comrades he knew killed then; that he was then treated by Dr.
Amidon, who went onto the beach as well; that the doctor put
him in a shack to rest and administered pills, and put him on
sick call but did not force him to leave his outfit, per the
veteran’s request; that he had a nervous-type psychiatric
condition which persisted from that time forward; that he did
not thereafter seek treatment in service for the psychiatric
condition, out of fear of being separated from his comrades
in his outfit; that in service he experienced other combat
situations or otherwise stressor situations in the invasion
of Normandy, in the liberation of Buchenwald, as well as at
other stationings during World War II in North Africa,
Sicily, Salerno, England, Ireland, Scotland, and Belgium;
that he also worked in service locating and disarming mines,
and helped in pulling bodies out of the wreckage of vehicles;
that upon separation from service he reported his incurrence
of the nervous condition in service, but opted to return home
rather than be detained in order to undergo a medical
examination; that post service his nervous-type condition
persisted, but he overlooked it and did not seek treatment
again until 1949 or 1950, after he was married; and that he
received intermittent treatment, including medication, for
his nervous condition from that time until the present.
The Board notes that in a July 1989 psychiatric examination
for compensation purposes, on which (in part) the February
1991 Board decision was based, the veteran reported a history
of his psychiatric symptoms and treatments beginning with his
treatment for shell shock suffered at the invasion of Utah
Beach on June 6, 1944. The examiner, following review of the
claims file, concluded that the veteran had a psychiatric
condition that had some symptoms of PTSD but did not warrant
such a diagnosis, but concluded that the veteran did have a
generalized anxiety disorder that began while in service and
had been mildly incapacitating over the years.
Evidence related to the veteran’s claim added to the claims
file subsequent to the last final denial by the Board in
February 1991, consists of statements by the veteran
including May 1993 RO personal hearing testimony, service
records and documentation of medals awarded, Department of
Defense statements on the activities of the veteran’s service
regiment, a Department of Defense statement related to the
status of the veteran’s service records, published
documentation related to unit service citations, a unit
history extract of the 531st Engineering Shore Regiment,
April 1993 VA outpatient treatment notes, and two June 1993
VA PTSD examination reports for compensation purposes. All
of that evidence was either copies of submissions received
prior to the February 1991 prior denial by the Board, or as
in the case of the veteran’s statements and the Department of
Defense report, was merely duplicative in substance of
evidence received prior to the February 1991 last prior
denial, with the exception of the Department of Defense
statement regarding the status of the veteran’s service
records, the April 1993 VA outpatient treatment notes, and
the two June 1993 VA PTSD examination reports.
A March 1990 letter from the Department of Defense, U.S. Army
Reserve Personnel Services Center, informed, in pertinent
part, that the veteran’s service records were destroyed in a
major fire on July 12, 1973. However, because the veteran’s
service medical records appear to have been added to the
claims file in November 1972, that statement by the U.S. Army
Reserve Personnel Services Center is dismissed by the Board
as inaccurate.
The April 1993 outpatient report concluded that the veteran
was severely affected by World War II, continued to obsess
about that war, and seemed to have PTSD. The examiner
diagnosed, in pertinent part, moderate to severe PTSD, as
well as depression. The examiner prescribed Zoloft and
Ativan.
The first of the two June 1993 VA PTSD examiners noted the
veteran’s service history including D-day invasion of
Normandy, presence at Buchenwald, and stationing in many
other areas in Europe and Africa during World War II in war
zones. Also noted were the unavailability of his post-
service private treatment records, the veteran’s
participation in VA outpatient psychotherapy which he no
longer attended, and his present medication with Zoloft. He
was noted to be a stone cutter and brick layer, retired 13
years prior to the examination. The veteran complained of
feeling saddened and becoming tearful upon remembering his
war and the deaths of those he knew, having nightmares about
the war approximately once per month, and feeling nervous and
tremulous since his separation from service. Objectively,
the veteran was a well-groomed, elderly man who became
transiently distressed during the interview. Speech was of
normal rate, tone, and volume. Bilateral upper extremity
tremors were noted. Mood was dysphoric. Affect was full and
appropriate. Thought patterns were goal directed with
frequent tangential associations related to war experiences.
Thought content was without auditory or visual hallucinations
and without delusion. The veteran had insomnia, but had no
change in appetite. He had no suicidal or homicidal
ideations. Insight and judgment were fair. Mental status
examination results were 27/30. With reference to specific
criteria for PTSD, the examiner concluded that the veteran
had been exposed to severely distressing events, including D-
day at Normandy and entering Buchenwald; that he had
recurrent intrusive recollections and dreams of these events;
and that he had insomnia since that war and not previous to
that time, as well as an exaggerated startle response; but
that he did not have any of the avoidance criteria of PTSD.
The examiner diagnosed an anxiety disorder, not otherwise
specified, which was not PTSD for lack of avoidance criteria.
The examiner concluded that the anxiety disorder was related
to the veteran’s service in that his emotional distress was
related to his experiences during World War II.
The second of the two June 1993 VA PTSD examiners noted that
the veteran’s case file contained the veteran’s contentions
of stressor experiences and treatment for a nervous disorder
in service. The examiner also noted current contentions by
the veteran of current treatment at a VA facility on an
outpatient basis every two months. The examiner noted the
substance of the Board’s denial in February 1991. The
veteran complained of a sleep problem in which he got exactly
four hours sleep per night since separation from service,
with thoughts about the war upon going to sleep. The
examiner noted that the veteran’s complaints of insomnia,
flashbacks, and other symptomatology were described in a rote
and rigid manner as if they had been learned, did not meet
the specific criteria of PTSD in each case, and did not have
the variability that would be expected in PTSD cases. The
examiner found the veteran to be extremely ingratiating in
his manner, with attempts to talk entirely about his war
experiences, and monotony in the telling which suggested a
recital, lacking emotion in the telling as would be typical
in a PTSD case. Objectively, the veteran was neatly and
informally dressed. He was able to give concise and relevant
responses when given some structure, though his speech was
otherwise somewhat tangential and circumstantial. Mood
appeared within normal limits and not inappropriate. No
evidence of anxiety syndrome, suicidal ideation, or psychotic
thought content was present at the time of examination. The
veteran was alert, oriented, and cooperative, but he tended
to want to focus on his own version of PTSD symptoms and
expressed these in a rote fashion. Memory, intelligence, and
general fund of information were passing. Calculation was
poor. Proverb interpretation, differentiation of similar
things, and judgment were passing. The examiner assigned no
diagnosis under Axis I or Axis II. No serious psychosocial
stressors were found, and a global assessment of functioning
(GAF) of 70 was assigned, corresponding to no serious
interference in functioning due to psychiatric causes at the
present time.
The Board finds that the first June 1993 VA PTSD examination
report constitutes new and material evidence, in that it is
new evidence pertaining to the issue of incurrence of a
psychiatric condition in service which, when consider
together with all the evidence of record, both new and old
creates a reasonable possibility of a change in the outcome
of the case. In making this determination, the Board notes
that that examiner found that the veteran did suffer from a
psychiatric condition which was causally linked to his period
of service.
Once the case is reopened, the Board is left with the
question of whether the veteran is entitled to service
connection for his psychiatric condition.
Initially, the Board finds the veteran’s claim for
entitlement to service connection well grounded pursuant to
38 U.S.C.A. § 5107 (West 1991) in that his claim is
plausible. Murphy v. Derwinski, 1 Vet.App. 78 (1990).
Once it has been determined that the claim is well grounded,
the VA has a statutory duty to assist the veteran in the
development of evidence pertinent to the claim. 38 U.S.C.A. §
5107. The Board is satisfied that the RO has made all
reasonable efforts to obtain all available evidence pertinent
to the claim and that proper appellate development, including
appropriate notice to the veteran, has been made. The Board
is satisfied that all available evidence necessary for an
equitable disposition of the appeal has been obtained. The
Board therefore finds that the duty to assist has been met.
Service connection may be granted for a disability which is
incurred in or aggravated by service. 38 U.S.C.A. § 1110
(West 1991). The implementing regulations provide that
continuity of symptomatology is required where a disorder
initially identified during service is not shown to be
chronic or where the diagnosis of chronicity may be
legitimately questioned. 38 C.F.R. § 3.303(b) (1996). The
implementing regulations also provide that a disability
initially diagnosed after service may be service connected
where a review of all the evidence, including that pertinent
to service, establishes the disability was incurred in
service. 38 C.F.R. § 3.303(d) (1996).
With a chronic disease shown as such in service (or within an
applicable presumptive period), subsequent manifestations of
the same chronic disease at any later date are service
connected unless clearly attributable to intercurrent cause.
This rule does not mean that any manifestation of joint pain,
any cough, or any urinary finding of casts in service will
permit service connection for arthritis, pulmonary disease,
or nephritis first shown as a clear-cut entity at some later
date. For the showing of chronic disease in service, a
combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or a diagnosis including the word "chronic," is
required. Continuity of symptomatology is required only
where the condition noted during service (or in the
presumptive period) is not, in fact, shown to be chronic, or
where the diagnosis of chronicity may be legitimately
questioned. When the fact of chronicity in service is not
adequately supported, then a showing of continuity after
discharge is required to support the claim. 38 C.F.R. §
3.303(b) (1996).
In this case, though the veteran’s service medical records
fail to show a record of treatment for a psychiatric
condition, the claims file contains numerous statements from
the veteran’s service comrades to the effect that the veteran
was treated for a psychiatric condition on a number of
occasions, and that this condition was characterized at first
as “shell shock” and later as nervousness. Statements from
Dr. Amidon, a physician with the veteran’s regiment, confirm,
if nothing else, that it is possible that Dr. Amidon treated
the veteran for his nervous condition or for shell shock and
there was no record made, because of the number of casualties
Dr. Amidon was treating on D-day and thereafter. Post
service records show that the veteran was treated for a
nervous condition, described by Dr. Derrico in a November
1977 letter as anxiety neurosis, at least since 1950,
approximately five years post service and has been treated
for that condition intermittently thereafter. There are two
VA medical opinions linking the veteran’s current psychiatric
condition to service. The first, in July 1989, concluded
that the veteran incurred a psychiatric condition in service,
and diagnosed it as an anxiety disorder. The second, in June
1993, diagnosed a generalized anxiety disorder, not otherwise
specified, which was manifested by emotional distress related
to his experiences in service in World War II. Thus, taken
together, these VA medical opinions describe an anxiety
disorder which is causally related to service. These
examinations together with prior evidence of record would
thus be sufficient to service connect a psychiatric disorder,
as a chronic condition incurred in service and causally
related to service.
The veteran did have a second VA examination in June 1993 in
which the examiner discounted the veteran’s symptomatology as
related to PTSD, as being mere rote recitation of learned
symptoms. That examiner made no diagnosis in either Axis I
or Axis II. However, the Board notes that that examiner
focused his assessment on PTSD, and did not adequately
address the possibility of other psychiatric disorders. That
examiner found no anxiety disorder or other psychiatric
condition manifested on the day of the examination, but the
Board is unwilling to conclude on that basis that no
psychiatric condition of any description is present. On the
basis of the first VA PTSD examination in June 1993, the July
1989 VA examination, and other evidence of record, the Board
concludes that the preponderance of the evidence is in favor
of a conclusion that the veteran has an anxiety disorder
which was incurred in service. The Board therefore concludes
that the preponderance of the evidence favors the veteran’s
claim for entitlement to service connection for a psychiatric
condition.
However, the Board finds that the preponderance of the
evidence is against the claim of entitlement to service
connection for PTSD, for lack of a current diagnosis of PTSD.
Though PTSD was provisionally diagnosed in a VA outpatient
treatment record in April 1993, two thorough VA examinations
of the veteran in June 1993 on the question of PTSD found
that PTSD was not present.
(CONTINUED ON NEXT PAGE)
ORDER
1. Service connection for an anxiety disorder is granted.
2. Service connection for PTSD is denied.
J. E. DAY
Member, Board of Veterans' Appeals
38 U.S.C.A. § 7102 (West Supp. 1996) permits a proceeding
instituted before the Board to be assigned to an individual
member of the Board for a determination. This proceeding has
been assigned to an individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1996), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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